DO THE CONVENTIONAL CLINICOPATHOLOGICAL PARAMETERS PREDICT FOR RESPONSE AND SURVIVAL IN HEAD AND NECK-CANCER PATIENTS UNDERGOING NEOADJUVANT CHEMOTHERAPY

Aims and background: Neoadjuvant chemotherapy for head and neck carcin oma is still an important treatment modality. The prognostic value of patient and tumor parameters has been extensively evaluated in several trials, yielding mixed results. We report the prognostic factors emer ging from a group of patients undergoing neoadjuvant chemotherapy. Pat ients and methods: From April 1986 to June 1992, 149 consecutive patie nts received cisplatin-5-fluorouracil-based neoadjuvant chemotherapy. After four courses of chemotherapy, patients underwent local-regional treatment with surgery, radiation or both. A variety of patient and tu mor characteristics were evaluated as predictors for response to chemo therapy and survival. Results: The complete response, partial response and no response rates to NAC were 52%, 33% and 15%, respectively. No parameters predicted response to chemotherapy. At a maximum follow-up of 87 months, overall survival was 39% and disease-free survival was 4 9%. Variables shown to be predictors of survival in univariate analyse s were age, performance status, histology, site, T, N, stage, and resp onse to chemotherapy. Using the Cox regression analysis, only complete response to induction chemotherapy (p = 0.0006), performance status ( P = 0.03), stage (P = 0.01), age (P = 0.03) and primary tumor site (P = 0.04) emerged as independent prognostic factors for survival. Conclu sions: Complete response to chemotherapy was confirmed as the stronges t prognostic factor influencing survival. However, conventional clinic opathologic factors did not predict response, hence, potential prognos tic biologic and molecular factors for response must be sought. At pre sent, much effort must be made for the improvement of the complete res ponse rate, which seems to be a requisite to prolong survival.